This is a case report of a 44-year-old obese female who developed subclinical hepatic injury 4 weeks after starting metformin for type 2 diabetes. She had a rise in her alanine aminotransferase which peaked at 5 months (738 U/l) and rapidly declined within days of discontinuing her metformin. No other positive evidence of alternative causes for the hepatic injury was found. The likelihood of metformin-induced injury was 7 on the Naranjo scale of adverse drug reactions. A brief review of the 11 previously reported cases in the English medical literature is also made.
A commentary and analysis on the miscommunication of medication names between native Arabic-speaking patients and pharmacists with a native English-speaking family physician using Medical English as a Lingua Franca (MELF), in a healthcare context. An important cause of communication difficulties is the different way native English and native Arabic speakers linguistically process medication names when using MELF. This is likely to be explained by the differences in the native grammars of English and Arabic which determine differences in pronunciation and predict potential error prone groupings of letters and sounds. This in turn leads to repeating linguistic errors such as epenthesis (insertion of additional vowels between consonants) and metathesis (the swapping of adjacent consonants). The article highlights a case where both epenthesis and metathesis occur simultaneously leading to a potential serious adverse event through a medication error and suggests further avenues of research to minimise such errors.
Background. Essential hypertension is a common, significant worldwide disease whose adequate treatment requires a multidrug regime in 70% of patients, where adherence to treatment ranges from low to very low (72.7% to 19.7%), and where each additional medication used causes a decrease in adherence by up to 85%. Hibiscus sabdariffa L. (HS) is a widely used herb which has been used for its antihypertensive effect, which may offer to play a useful synergistic role to pharmacotherapy. Objectives. This review sought to identify relevant basic laboratory studies, human randomised controlled studies (RCTs), meta-analysis and reviews studying the safety, mechanism and/or effect of HS on blood pressure. Material and methods. A search was done, ending on the 1st of October 2019, of the following databases: Medline, COCHRANE and EMBASE. RCTs were assessed for quality using the Jadad scale. Results. Basic laboratory studies have shown that HS is rich in bioactive anthocyanins, which inhibit angiotensin-converting enzyme (ACE) in a dose-dependent manner, and HS extracts also have a direct vasodilator effect. 13 safety studies have found HS to be safe at normal doses with minimal clinically important drug-herb interaction. Very high doses (> 300 mg/kg/day) are associated with liver enzyme abnormalities and raised uric acid in rat studies. 14 RCTs show that HS causes a significant reduction in systolic blood pressure (-6.3 to -31.9 mm Hg) and diastolic blood pressure (-1.1 to -19.7 mm Hg). Conclusions. HS is a widely available, acceptable, cheap and effective synergistic agent in the management of essential hypertension.
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